PTSD or personality disorder? It matters to soldiers
Filed under: Government, Health journalism, Health policy, Studies
The AP’s Anne Flaherty has put together a story that illuminates the Army’s refusal to admit that it could have misdiagnosed (and discharged) hundreds of soldiers who may have had PTSD or traumatic brain injury instead of a personality disorder. Keep in mind that a discharge for “personality disorder” means no veterans’ benefits and a lifetime of stigma. A diagnosis of PTSD or injury, on the other hand, means treatment will be covered by the government.
Photo by isafmedia via FlickrThe Army, for its part, has decided there’s nothing unusual about the following chain of events (taken from Flaherty’s story):
- The Army “discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.”
- In 2007, The Nation’s Joshua Kors writes a cover story exposing the Army’s apparent habit of diagnosing soldiers with a personality disorder instead of considering the possibility of PTSD or traumatic brain injury.
- Soon after, “the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn’t the underlying cause.”
- Sure enough, “the annual number of personality disorder cases dropped by 75 percent.”
- At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
- Army officials “reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006″ and said they “did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder.”
Heisel’s ‘Doctors Behaving Badly’ goes viral
Filed under: Health data, Health journalism, Hot Health Headline, Member news, Nursing
As anybody who follows the Reporting on Health blog knows, William Heisel’s virtual roadshow of physician background research has been gaining ridiculous amounts of steam lately. His Doctors Behaving Badly brand has taken on a life of its own, propelled by a Google Map he put together to place his findings into geographic context.
View Doctors Behaving Badly in a larger map
That geographic context has become the focus of his investigation, as Heisel has turned what was once a quirky little recurring item into a systematic, state-by-state way into how the public can check up on disciplined (or otherwise problematic) doctors. He’s almost reached the halfway point, and he’s reached some interesting conclusions. My favorite is that he doesn’t think states that have terrible sites with which to check up on doctors are being malicious, they’re just bad at making websites.
I think the problem lies in poor website design. A board starts with a simple site that allows people to see if a doctor has a valid license. Then that same board adds scanned documents from its disciplinary files, but instead of linking these two things together, it puts them in completely different parts of its site. When the board gets around to adding malpractice information or criminal histories, it layers those on top, too, instead of fully integrating them.
The effect is a stratified system of information that lets patients think their physicians have a clean history when, in fact, their records are simply too hard to find.
Heisel recently appeared on Fox News to explain what he’d found thus far.
On the whole, Heisel’s effort helps illuminate the power of my favorite online reporting tool: The progressively investigated database.
Study: Foreign training doesn’t affect care
Filed under: Europe, Health policy, Hot Health Headline
A Health Affairs study evaluating the relative quality of care provided by international medical graduates practicing in the United States has attracted attention from all quarters and reignited the discussion about medical licensing in this country.
First, a few background statistics pulled from Pauline Chen’s commentary in The New York Times.
- About 25 percent of all practicing physicians in the U.S. graduated from international schools (Canada is not considered international in this context)
- 20 percent of those are Americans who studied medicine abroad, usually in the Caribbean
- 30 percent of the nation’s primary care doctors graduate from international med schools
Chen, again:
… it turns out that contrary to certain individuals’ worst fears, accent or nationality did not affect patient outcomes. Rather, the main factor was being board-certified: completing a full residency at an accredited training program, passing written and, depending on the specialty, oral examinations, and having proof of experience with a defined set of clinical problems and technical procedures.
There was, however, one key difference, and it came in primary care. Patients of foreign-born primary care doctors fared better than patients of American primary care doctors. “The foreign international medical graduates are some of the smartest kids from around the world,” said John J. Norcini, lead author of the study . “When they come over, they tend to fill in where the U.S. medical school graduates don’t necessarily go.”
If you’re looking for further background on the international component of America’s physician workforce, I recommend the AMA’s 2010 profile of international medical graduates. As you can see below, 20 countries taught more than 70 percent of the international medical graduates in the United States.
Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.
EPA changes would improve public access to data
Filed under: Government, Health data, Health policy, Hot Health Headline
A recent OMB Watch story covers the EPA’s latest attempt to leverage the Toxic Substances Control Act to make it easier for the public to access chemical data and harder for manufacturers to hide health and safety related information behind the “trade secrets” label.
Fire and emergency response personnel practice techniques for hazardous materials containment and removal. (CDC photo)
The key is the expansion of the Inventory Update Reporting rule, which requires companies to report toxic substances over a certain weight threshold. According to OMB Watch, the Bush administration bumped this threshold from 10,000 to 25,000 pounds, and decreased reporting frequency from every four years to every five years.
The proposed rule lowers or eliminates thresholds for reporting and increases reporting frequency, moves that should provide the public with more information on more chemicals. The amount of a chemical manufactured at a facility in any given year fluctuates widely. … EPA’s proposed rule would require a manufacturer to submit information on a chemical if the volume exceeds the 25,000-pound threshold for any year since the previous submission. The agency is also proposing to return the reporting frequency to every four years rather than every five. Additionally, EPA is proposing requiring all reporters to submit data on the processing and use of the chemicals. The current program requires such reporting only for chemicals manufactured or imported over 300,000 pounds.
The manufacturers would use EPA-provided software to report their chemical inventory – currently, most manufacturers submit paper reports. The paper reports take years to process and the data-entry process introduces extra error into the system.
Another proposed change would require reporting of a number of valuable pieces of information, such as yearly production volumes, more specific chemical names and numbers to ensure the correct chemical substances are identified, and the approximate number of workers exposed to the chemicals.
Furthermore, manufacturers currently can label just about anything as “confidential business information,” the new rules would place annual limits on the practice and require manufacturers to justify any such designations.
The Society of Environmental Journalists wrote about the issue back in March and included a link to a report [PDF] from the EPA’s Inspector General, as well as other coverage.
Concussion-related trauma masquerades as ALS
The New York Times‘ Alan Schwarz reports on what he says is “the first firm pathological indications that brain trauma results in motor-neuron degeneration.” The headline behind that conclusion, of course, is that researchers say some athletes with concussion and impact-induced brain injuries may have been misdiagnosed as ALS victims.
Photo by peterjr1961 via Flickr
In interviews, the study’s authors even speculate that Lou Gherig, who gave the disease its popular name, may have instead suffered from a similar disease caused in part by brain injuries.
The finding was not unexpected, given that ALS seemed to occur at much higher rates in concussion-heavy populations like athletes and soldiers.
Schwarz’s summary of the study:
Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicate that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.
It’s in the emergence of that second disease that really seems to have attracted Schwarz’ attention. It behaves similarly to ALS, but shows a distinct protein pattern that only seemed to emerge in patients with a history of head injury. There is not, however, a 1:1 relationship. Other factors seem to also be at play, Schwarz writes.
Gary Schwitzer of HealthNewsReview.org examines the story more closely and concludes that, while this is an “important and fascinating area of research,” the story “did not exhibit the best of health/medical/science journalism.” He lists seven points of criticism and includes comments from one of the site’s medical editors.
John Gever of MedPage Today offers more scientific coverage of the study and points out that there was no mention of Gehrig in the study but that “a New York Times reporter coaxed McKee into suggesting that Gehrig may have been among those misdiagnosed – even though, as a first baseman, he did not routinely experience violent collisions. (He was, however, beaned at least twice during his 14-year career with the New York Yankees.)”
Missouri data disclosure details infection fight
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public health, Public records, Studies, Tools
Missouri law requires hospitals to disclose infection rates for intensive care and certain surgeries. It doesn’t keep that data around for long, but St. Louis Post-Dispatch reporter Jim Doyle still managed to review data from 2005 to 2009.
Robots sanitize an ICU room by spraying hydrogen peroxide vapor into the air at St. John’s Mercy Medical Center.
He found that while numerous local hospitals lagged behind national infection rates, most were improving. A story that could have been a dire assessment of health care-associated infections instead became (mostly) a profile of local hospitals’ drive to cut down on the transmission of such infections. He doesn’t draw a clean line between the state’s monitoring and increased anti-infection efforts, but it’s tempting to read between the lines.
Doyle’s second installment continues the theme, discussing the aggressive, nonstop effort that is required to contain drug-resistant bacteria. Measures range from checklists to room-enveloping antibacterial vapors.
Missouri’s disclosure laws are an important step toward infection fighting, Doyle found, but their narrow definition allows hospitals some wiggle room and may miss serious systemic issues. Speaking of systemic issues, I highly recommend Doyle’s sidebar on why Missouri infection data is so hard to keep around.
UK hospitals fail to comply with safety alerts
Filed under: Europe, Hospitals, Hot Health Headline
Following medical errors and patient safety issues, the United Kingdom’s National Patient Safety Agency issues national safety alerts so that hospitals can change their practices and avoid repeat occurrences. As The Daily Telegraph’s Rebecca Smith reports, a patient advocacy group has found (28-page PDF) that two-thirds of UK hospitals have failed to meet the implementation deadline on at least one alert.
The group blames haphazard enforcement and monitoring for the lapses.
Action against Medical Accidents warned that despite repeated warnings that the alerts were not being complied with, there was no central policy or guidance on which organisation should be monitoring compliance and what action should be taken.
Smith focused on two particularly serious issues, the inappropriate administration of oxygen and injectable medicines. The report groups instances of noncompliance by hospital and by alert.
Blogging the first day of AHCJ boot camp
The Columbia Daily Tribune’s Jodie Jackson Jr., who is one of AHCJ’s Midwest Health Journalism Program Fellows, is blogging about this week’s AHCJ Health Reporting Boot Camp on his North County News blog. Jackson writes that, after day one, he’s already enjoying spending time in the company of other like-minded journalists and learning from some of the profession’s finest.
It was a good start to what promises to be a busy, information-packed week of learning new and honing old skills to provide more and deeper coverage of health care issues, or as Len Bruzzese put it, finding ways to create “a smarter, more engaged public,” and “hopefully a more responsive government.” Pretty heady issues, but Bruzzese seems in position to make that challenge.
The boot camp, which is designed for the eight Midwest Fellows and select students of Missouri School of Journalism, runs through Friday. Jackson promises that he’ll keep blogging as the week goes on, so check North County News (and Covering Health!) for updates.
AHCJ welcomes 11 new members
These journalists joined AHCJ last week:
- Alan Cassels, independent journalist; Victoria, British Columbia (@AKECassels)
- Chuck Kurtz, staff writer, Sun Publications; Overland Park, Kan.
- Valerie Lego, health reporter, WZZM-Grand Rapids, Mich. (@valerielego)
- Erin Marcus, independent journalist; Key Biscayne, Fla.
- Julia Paulus, editor/writer; Kansas City, Mo.
- Shanderia Posey, healthscene editor, The Clarion-Ledger; Jackson, Miss.
- Kelly Puente, reporter, Long Beach Press-Telegram; Long Beach, Calif.
- Cynthia Roby, independent journalist; Fort Lauderdale, Fla.
- Joaquin Sapien, reporter, ProPublica; New York City
- Larry Seward, reporter, KSHB-Kansas City, Mo. (LOSewardII)
- Kimber Wallace, reporter, The Manhattan Mercury; Manhattan, Kan. (Kimburglar)
If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.
Globe photographer finds medical records in landfill
Filed under: Health journalism, Hospitals, Hot Health Headline
The Boston Globe’s Liz Kowalczyk tells the story of how one of the paper’s staff photographers stumbled upon a massive medical privacy breach while dumping his trash.
Photo by D’Arcy Norman via Flickr
As Tinker Ready points out on Boston Health News, it’s a reminder that stories are everywhere … and shredders are not. Kowalcyzyk traced the documents to a billing intermediary.
Kowalcyzk uses the landfill scene to demonstrate just how difficult it is for hospital officials to keep confidential information from slipping through the cracks.
The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
